HB0235 Enrolled LRB099 03691 MLM 23702 b
1		AN ACT concerning insurance.
2		Be it enacted by the People of the State of Illinois,
3		represented in the General Assembly:
4		Section 5. The Illinois Insurance Code is amended by
5		changing Section 356z.2 as follows:
6		(215 ILCS 5/356z.2)
7		Sec. 356z.2. Coverage for adjunctive services in dental
8		care.
9		(a) An individual or group policy of accident and health
10		insurance amended, delivered, issued, or renewed after the
11		effective date of this amendatory Act of the 92nd General
12		Assembly shall cover charges incurred, and anesthetics
13		provided, in conjunction with dental care that is provided to a
14		covered individual in a hospital or an ambulatory surgical
15		treatment center if any of the following applies:
16		(1) the individual is a child age 6 or under;
17		(2) the individual has a medical condition that
18		requires hospitalization or general anesthesia for dental
19		care; or
20		(3) the individual is disabled.
21		(a-5) An individual or group policy of accident and health
22		insurance amended, delivered, issued, or renewed after the
23		effective date of this amendatory Act of the 99th General

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1		Assembly shall cover charges incurred, and anesthetics
2		provided by a dentist with a permit provided under Section 8.1
3		of the Illinois Dental Practice Act, in conjunction with dental
4		care that is provided to a covered individual in a dental
5		office, oral surgeon's office, hospital, or ambulatory
6		surgical treatment center if the individual is under age 19 and
7		has been diagnosed with an autism spectrum disorder as defined
8		in Section 10 of the Autism Spectrum Disorders Reporting Act or
9		a developmental disability. A covered individual shall be
10		required to make 2 visits to the dental care provider prior to
11		accessing other coverage under this subsection.
12		For purposes of this subsection, "developmental
13		disability" means a disability that is attributable to an
14		intellectual disability or a related condition, if the related
15		condition meets all of the following conditions:
16		(1) it is attributable to cerebral palsy, epilepsy, or
17		any other condition, other than mental illness, found to be
18		closely related to an intellectual disability because that
19		condition results in impairment of general intellectual
20		functioning or adaptive behavior similar to that of
21		individuals with an intellectual disability and requires
22		treatment or services similar to those required for those
23		individuals; for purposes of this definition, autism is
24		considered a related condition;
25		(2) it is manifested before the individual reaches age
26		22;

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1		(3) it is likely to continue indefinitely; and
2		(4) it results in substantial functional limitations
3		in 3 or more of the following areas of major life activity:
4		self-care, language, learning, mobility, self-direction,
5		and capacity for independent living.
6		(b) For purposes of this Section, "ambulatory surgical
7		treatment center" has the meaning given to that term in Section
8		3 of the Ambulatory Surgical Treatment Center Act.
9		For purposes of this Section, "disabled" means a person,
10		regardless of age, with a chronic disability if the chronic
11		disability meets all of the following conditions:
12		(1) It is attributable to a mental or physical
13		impairment or combination of mental and physical
14		impairments.
15		(2) It is likely to continue.
16		(3) It results in substantial functional limitations
17		in one or more of the following areas of major life
18		activity:
19		(A) self-care;
20		(B) receptive and expressive language;
21		(C) learning;
22		(D) mobility;
23		(E) capacity for independent living; or
24		(F) economic self-sufficiency.
25		(c) The coverage required under this Section may be subject
26		to any limitations, exclusions, or cost-sharing provisions

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1		that apply generally under the insurance policy.
2		(d) This Section does not apply to a policy that covers
3		only dental care.
4		(e) Nothing in this Section requires that the dental
5		services be covered.
6		(f) The provisions of this Section do not apply to
7		short-term travel, accident-only, limited, or specified
8		disease policies, nor to policies or contracts designed for
9		issuance to persons eligible for coverage under Title XVIII of
10		the Social Security Act, known as Medicare, or any other
11		similar coverage under State or federal governmental plans.
12		(Source: P.A. 95-331, eff. 8-21-07.)